The Profession that Addresses Overall Well-Being

The Canadian Physiotherapy Association (CPA) has approximately 14,000 members to date, comprised of physiotherapists, physiotherapy assistants, businesses and those in academia. These are in fifteen specialized divisions, and there is a branch in each province and territory.
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Health is the greatest of human blessings Hippocrates once said. No one would deny this as being a universal truth. Good health leads to more fulfilling lives and overall happiness. To be blessed with good health is not a guarantee at birth. It takes a conscientious effort and a real desire to maintain the whole body system at its optimum level.

But sometimes, despite our best attempts, a healthcare professional will need to intercede – to correct a problem whether self-imposed or otherwise. As a profession, physiotherapists have a vital role in our health care delivery system.

At one time, a physiotherapist was referred to as a masseuse, a term which didn’t fittingly describe this professional role accurately. After World War II the term physiotherapist became widely recognized, “essentially because of the extended role,” says Kate O’Connor, Director, Practice and Policy at the Canadian Physiotherapy Association (CPA), headquartered in Ottawa, Ontario.

“It wasn’t just about sort of that manual therapy related to massage, but about the biomechanical and physiological knowledge of the human body. There was an expansion of the knowledge around the human body which progressed into the physiotherapy profession.”

It was Enid Graham who founded the Canadian Association of Massage and Remedial Gymnastics (CAMRG) in 1920, which was later incorporated in 1935 and renamed the CPA. Kate says that this year, the Canadian government has recognized Enid Graham as a person of national historic significance and a plaque was unveiled at the University of Toronto’s (U of T) Hart House in September 2017. “It’s the one-hundredth anniversary of the program at U of T this year which Enid Graham was part of.”

The CPA’s divisions include acupuncture, cardiorespiratory, oncology, paediatric, pain science, and sport. The CPA’s sport division – Sport Physiotherapy Canada – has seen much activity lately because, “recently, there were concussion guidelines that came out for sport,” says Kate, adding that this division has been, “very active in helping to contribute to and create the Canadian guidelines for concussion in sport. They are a valued part of the association’s professional team.”

The CPA’s pain science division is a newcomer that is also proving to be invaluable to the association, particularly in response to the opioid crisis in this country. “We’ve been doing a lot of work about the roles of physiotherapy and the response to the opioid crisis,” Kate adds.

She explains that response to the opioid crisis is often focused on illicit street drugs, and there is not much conversation about what is driving individuals to the point of abuse. “Physiotherapy is often not covered under the public health insurance programs in Canada. About fifteen years ago, it started to be delisted from provincial health plans. So it’s much easier to get a prescription for a painkiller as opposed to getting the care to respond to the root of the pain.”

Over the past year, the pain science division has been aiding in looking at non-pharmacological options and providing, “expertise to share with governments about why opioids are not effective in treating pain despite the fact that they are often being prescribed for pain.”

Kate notes that some pharmaceutical companies have been providing what she believes is, “biased education toward subscribers,” asserting that such companies have not been entirely forthright about long-term effects or impacts of opioid use on individuals and the accompanying addictions. These companies have managed to approach family physicians and other prescribers to say that the product is “safe and effective when evidence shows that it’s not.”

The CPA has conducted a collaborative strategic planning process which includes meetings with branches, divisions, and its board of directors to assure synchronicity of the association’s vision. “We have aligned all of our strategic priorities, and there was feedback from all the different groups to be able to determine what our new vision, mission statement, and values will be starting in 2018 for our next strategic plan.”

The association is comprised of a great number of components and is thus a very complex organization, but this new strategic plan excites Kate. “It really has a focus on enhancing the value of the association and working together cooperatively to be able to move forward common issues and agendas.”

The CPA is a founding member of the World Confederation for Physical Therapy (WCPT). The WCPT represents physical therapists in Africa, Asia, Caribbean, North and South America and the Western Pacific through its 111 member organizations. “As a founding member, we wanted to take the strength of some of the more developed physiotherapy associations in typical western countries,” explains Kate, saying that Canada, the United States, the United Kingdom, Australia and New Zealand share a common advanced scope of practice.

The CPA wants to, “work with many other countries that have more emerging professions and associations to be able to support them, to translate knowledge and evidence, and ensure that there’s almost a mentoring of other associations and professionals. There can be access to physiotherapy and rehabilitation in general.”

The association is aligned with a number of physiotherapy partnerships which include the Canadian Alliance of Physiotherapy Regulators (CAPR), the American Physical Therapy Association (APTA), and the Canadian Pharmacists Association (CPhA). Through these, the CPA has garnered, “a greater knowledge and awareness of what physiotherapy is and how it contributes to the more holistic approach to population health and health outcomes,” affirms Kate.

This ability to recognize the roles and values of physical therapists and the industry in general enables “recognition within the health system and also awareness from the population as a whole how physiotherapy can contribute to health and mobility for Canadians.”

The physiotherapy industry is constantly shifting, especially in the last couple of decades. New regulations within provinces, technological advances and indeed cultural shifts seem to indicate that individuals want to be more involved with self-care. This is where the CPA plays another vital role.

Kate explains that physiotherapy is not just about rehabilitation or post-injury treatment. It is much more and involves, “education and awareness of individuals so that they can either prevent injury or can work to self-manage complex conditions or chronic conditions.”

She notes, for example, the present and growing problem of type 2 diabetes or adult-onset diabetes, “which is largely developed because of lifestyle.” Physiotherapy can be utilized in the management of diabetes because, “mobility, exercise and general improvement of physical health can help to manage the disease without pharmaceuticals.” As an educator, the physiotherapist can make recommendations as to how sedentary individuals may improve their physical activity and strength in a safe and monitored manner.

With respect to the CPA’s educational component, Kate continues that, “The physiotherapist’s role as educator is very important for population health, health literacy and awareness as well as being the provider of care after illness, accidents or injury. That’s one piece related to population health outcomes that I think is really important.”

Changing demographics and an aging population will present challenges in itself that, as professionals, physiotherapists will need to address. An aging population will create a strain on resources, such as institutions that will need to house the aged. “The role of the physiotherapist with the aging population is actually being able to maintain health for a longer period of time to allow people to either stay at home or stay in a community,” says Kate.

And if and when an individual finds a need to enter a long-term facility the importance of some form of physical activity remains constant. Partaking in some form of physical activity can, “prevent falls, it can prevent other challenges that come with being inactive or sedentary,” continues Kate. “Overall, I think there has to be a greater awareness and focus on the role of other professionals, particularly in rehabilitation for managing population health as the population ages, as well as managing health care costs.”

The CPA will be hosting its inaugural Leadership Forum 2017 in November. This program was the result of a membership survey that indicated a need to comprehend better the role leadership development plays in everyday operations such as self-awareness and improvement and keeping abreast of the latest technological changes, for example. There hasn’t been a Forum of this kind in about 20 years.

“There’s so much change happening in practice right now that we wanted to be able to have different speakers talk about how to improve not only yourself but also your surroundings,” says Kate. These speakers will be leaders in their field from across the country who will engage in a two and a half day forum in Ottawa. “The program is phenomenal,” she says. “I was really impressed with how it has come together. I think it’s going to be a really great opportunity to network with other leaders and also just focus on how to become a better physiotherapist.”

In order to address other concerns, the CPA recently partnered with the Conference Board of Canada to understand market profiles, particularly with respect to a possible future shortage of physiotherapists. “It was surprising for us,” shares Kate. “We’ve heard anecdotally about challenges around recruitment, retention, and vacancy of physiotherapy positions in different areas of the country,” adding that the unemployment rate for Canadian physiotherapists is less than one percent.

Although individuals coming into the profession will have a job, there are other challenges of concern. In some areas physiotherapy positions are being replaced and in fact cut because “they simply can’t recruit,” says Kate. She adds that in Ontario kinesiologists are now regulated and that some of CPA’s members are concerned about encroachment on their scope of practice or being replaced with a kinesiologist that may not have the same level of education or specialized training.

“There’s a shift toward hiring lower skilled professionals in rehabilitation,” she says. “We want to be able to have a model of care that works for the patient, and we recognize that affordability of care is important for everybody. But we also are quite concerned that there’s going to be an erosion of the recognition of what a physiotherapist can do and how there’s an advanced skill set that really is accompanied with an expertise around assessment and diagnosis.” Eroding of physiotherapist’s recognition in the health care delivery system will be, “problematic for the profession down the road.”

The Canadian Physiotherapist Association is proactive in its promotion of the profession externally and champions its members, “To be the best possible health professionals that they can be,” concludes Kate. The association is, “really here to help lead, advocate and inspire excellence and innovation so that Canadians can have better health.”

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